Provider Demographics
NPI:1902630676
Name:MANOAH, LIZBETH (RN BSN IBCLC)
Entity type:Individual
Prefix:MRS
First Name:LIZBETH
Middle Name:
Last Name:MANOAH
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5147 SORRENTO BLVD E
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8533
Mailing Address - Country:US
Mailing Address - Phone:305-992-2081
Mailing Address - Fax:
Practice Address - Street 1:5147 SORRENTO BLVD E
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8533
Practice Address - Country:US
Practice Address - Phone:305-992-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9326298163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant